Strategies to reduce potentially avoidable hospitalisations among long-term care facility residents

Older people who reside in long-term care facilities (LTCFs) are frequently hospitalised.1 Hospitalisation in this vulnerable population is associated with iatrogenic conditions that often result in physical discomfort, psychological distress and functional disability, as well as excess healthcare costs. Several studies have demonstrated that a substantial proportion of these hospitalisations as well as emergency department (ED) visits that do not result in hospitalisation are potentially avoidable.2–12 Thus, efforts to reduce these potentially avoidable hospitalisations (PAH) could improve care quality and patient safety by reducing hospital and ED related complications, and save healthcare expenditures that could be used to further improve care. The paper by Lloyd et al describes one such effort carried out in 13 residential care and 10 nursing homes in the UK involving 568 residents and 568 matched control residents who entered similar LTCFs during the study period.13 All of these residents had been in the hospital at least once in the past 2 years, so that clinical data for propensity matching would be available. The intervention included regular visits by a designated primary care physician in order to provide continuity of care, and training and support for facility staff provided by community nurses. The intervention resulted in a statistically significant reduction in PAH, emergency hospital admissions and ED visits among the residential care home residents compared with the control group. However, there were no significant reductions in these events among residents of nursing homes and the control group. The authors suggest that these findings may have resulted from the intervention bolstering the clinical resources available to residential care homes more than it did for nursing homes, and/or had a greater potential to impact the health of the residential care home residents. The study was well designed and had a number of important strengths, including …